<p>sunnyflorida - I understand your position completely. As a physician you need to look out for your own patients. I am quite positive that my own gyn will not be making changes to her recommendations.
It is a good discussion and we need to acknowledge that there are clearly limitations to mammograms. Even the American Cancer Society recognizes this.
Women have a right to know that there are limitations and what they are. We have a right to know what the risk/benefit ratio is. We have a right to access scientific knowledge.</p>
<p>Studies show that mammograms in the 40’s does not have an affect on mortality - that is striking. Not that we can now safely wait until we are 50 but in how little progress has been made. If mammograms don’t work - let’s find something that does work.</p>
<p>The problem with mammograms is that, even at their best, they do not prevent, they detect. Despite that dreadful, and erroneous slogan-- Early detection is not the best protection–if you’ve detected, you are already past prevention.</p>
<p>How about research into the reasons for the serious increase in breast cancer. Four women, that I know of, who live within a few blocks of me have had breast cancer. One died, in her early 40s. </p>
<p>There is a lot of evidence that something about our environment is to blame. there is also evidence that diet can be linked–recommendations for alcohol intake for women have been lowered because of a strong link. </p>
<p>No one makes money from funding what might be killing us, and so less research money goes there.</p>
<p>All screening methods have costs as well as benefits, and you have to balance them. Costs of routine mammograms are not just the financial costs, but the risks that come from excess radiation, and from invasive procedures like biopsies.</p>
<p>My understanding is that the last time this panel addressed the same issue, six or seven years ago, the majority of the panel favored this change, but they were overruled by the head of the National Cancer Institute. I don’t think this is “political” in the sense of Obamacare, but there are warring factions in medicine over the philosophy of screening.</p>
<p>^^^ of course our environment has to be blamed. I don’t believe that cancer is genetic, I believe why people from the same family have it is because they eat the same food, and breathe the same air.
Just like some Drs don’t understand how MS tends to run in families, while there is no proof it’s genetic.
BTW, anyone seen the new finding about the high number of people with thyroid cancer who live in Eastern PA and some part of NY; Who also happened to live near Indian Point nuclear plant?</p>
Unfortunately some cancers are genetic. They can skip a generation and family memebrs might be hundreds of miles from each other. </p>
<p>When it comes to breast cancer and it being overdiagnosed here - one think that points to this being true is the fact that Europe does have about the same death rate from breast cancer as does US.</p>
<p>“I don’t believe that cancer is genetic, I believe why people from the same family have it is because they eat the same food, and breathe the same air.”</p>
<p>In most scientific studies, among other cogs, this has been looked at by examining “twins”, for example identical and raised apart.</p>
<p>On another thread, someone is saying “the same people who want universal health care are the ones opposed to the use of information like this”. I do not assume it’s the some people, but put the question to folks on this thread.</p>
<p>I recently got together with some doctors I used to work with in a staff model HMO. I left there for private practice about 10 years ago. While I still respect the way they practice medicine, and feel as if the “writing is on the wall”, it is interesting to notice how they base care on managing a population, while am more comfortable managing the individual.</p>
<p>I am always astounded when I hear about the breast cancer rate declining because I know so so so so many women (most in mid to late 40s) who have battled it. Almost no one in my mom’s generation - they’re all my age. </p>
<p>My pesonal theory is that it is due to all the nuclear testing that was done when our moms were pregnant with us and when we were little girls. My mom used to tell us not to eat the snow - not because of dog pee, but because of “fallout.” I thought she was nutsy, but it turns out that at the time, the radiation that hd been absorbed into the corn husks they used for packing materials for film was actually developing the film…there really WAS fallout in those Illinois corn fields. I think that breast cancer will peak with my generation.</p>
<p>“I don’t believe that cancer is genetic, I believe why people from the same family have it is because they eat the same food, and breathe the same air.”</p>
<p>^^There is plenty of scientific evidence linking genetics and breast cancer.</p>
<hr>
<p>If you think that companies that manufacture mammography instrumentation do not lobby for more screening, you are wrong. Just look at the Hologic stock today - their profits are at stake if these new guidelines are to be adopted. Unfortunately, I will continue giving my annual hugs to a Selenia for now, unless my doctor gets me off the hook (I seriously think she should).</p>
<p>What applies to the large group may be real and true and even factual (though scientific facts are constantly changing) </p>
<p>That does not mean an individual’s case is not different. A 1/10,000 chance of a bad outcome sounds pretty good unless it happens to you, then it is 100% happening to you! If the costs of pre-50 mammograms out weigh the benefits that could be true, but not if it is you or your mom or your sister.</p>
<p>Kind of like vaccines that are good for the military in a large group, but really bad for the couple of guys who have a bad reaction.</p>
<p>By the same token, I have to pay cash for most of my medical care and we have a lot of medical care avoidance, it is expensive, some times what feels quite unreasonably expensive. I am not enthusiastic about having a screening that will give me a high chance of a false positive. I have tuition to pay for, I don’t want to pay for an unnecessary biopsy etc. Of course, if I were to have something wrong, I would want the follow up testing I just don’t want to feel like sheeple getting in line for any random testing advised. </p>
<p>My Dad has been doing cancer for several years and I am amazed at how totally they and their excellent insurance are completely obedient to testing. Tests that show the progress of a specifically untreated disease. They have told him it is untreatable, why do more pet scans & cat scans just to know the progress, there is nothing they can do, no surgery, no chemo, nothing but making him comfortable so why test him? And why does the cardiologist recommend angiogram check ups? It’s not like any one is going to do cardiac surgery if anything is found, so why do invasive or expensive testing??</p>
<p>I agree, too, that this is likely to be used for insurance & medicare. What about mammograms after age 80? Do you still need it? I have a friend who wants to know why (post mastectomy) her mammogram is not half price if it is only on one side?? :D</p>
<p>^^Ha ha! (about the half price… how about per pound?)</p>
<p>Any thoughts about how we should address the cost piece if INDIVIDUALS are inclined toward anecdotal evidence, unscientific theories, and mistrust of government AND industry supported research?</p>
<p>I am not a female so chances of me getting breast cancer are slim, but my wife is battling it now. She missed a mamogram and the caner was detected in the next one (she just turned 50). I don’t understand how a fear of a false positive is a good reason to recommend these be skipped. I worry that the government and insurance companies will use this to deny coverage for women who do want them for peace of mind.</p>
<p>“I would much prefer to be “managed” as an individual.”</p>
<p>^^And I sort of agree, but the idea of universal health care begs the question of whether we prioritize the individual over the group. I don’t see how you can have it both ways. The HMO staff model is sort of a model for universal care. What are your thoughts about “universal healthcare” and/or a government option?</p>
<p>The recommendations of this panel, as far as I can tell from reading a few synopses in newspapers, does not establish a dichotomy between treating patients as individuals and establishing broad recommendations. The recommendations clearly state that exceptions are justified for those with elevated risk factors, including family history, other health factors, etc.</p>
<p>Just what do people want recommendations to be based on, if not well-done data analysis? In the past, it was believed that 40 was a good age to set as a base-line; now that much more data have been collected and pored over, the recommendation has been adjusted. That is how science works.</p>
<p>One of my complaints about the proposed increased government involvement in establishing health care treatment plans is that such recommendations as this may become ossified as the marketplace of ideas shrinks. There is no reason to be afraid of updated recommendations, assuming the science is sound.</p>
<p>The new recommendations are about managing individuals. That’s why they still call for screening of women with risk factors. They don’t call for routine screening of everybody, though. Those of you who don’t like the change, at what age do you think routine screening should begin? 30? 20? And what’s the basis for your opinion?</p>
<p>For the record, I agree with the research, but worry the devil is in the details.</p>
<p>When I worked for the HMO, the guidelines where developed by the physicians, and on the surface, made a lot of sense. But putting the guidelines into practice, with a population that was mistrustful, was quite difficult, at least in mental health. It was also true that due to limited resources, the “recommendations” where diluted over time, slowly enough that it snuck up on you. It felt like a slippery slope.</p>
<p>I think it’s disastrous to the health of a wellness oriented individual. I prefer to be able to choose an excellent, caring physician, have a values based discussion and then trust his or her clinical judgment over a government or insurance based demographic cost/benefit analysis.</p>
That would be nice, wouldn’t it? Of course, nobody who has health insurance of any kind has what you’re talking about. I guess there a few really rich people who have it.</p>
<p>^Hey! I think my patients have that with me! I believe the same is true for my husbands patients, and for other physicians as well. To me it seems you have to be careful about what contracts you sign, and about balancing the government and the commercially insured.</p>
<p>I (and Shrinkrap!) disagree. It’s true that insurance will commonly deny some diagnostic tests and procedures, and doctors sometimes won’t even recommend them because of that. You should be able to have a discussion where the MD says: “Your insurance probably won’t pay the $800 (hypothetical for sake of argument) for your mammogram because you’re under 50, but you are in a high risk category and probably should have one”, you can decide on your own whether it’s worth the out of pocket cost for you.</p>
I just don’t want to feel like sheeple getting in line for any random testing advised. </p>